1. Field of the Invention
The present invention relates to a system and a method for correlating medical procedures and medical billing codes and, in particulate, to a system and a method for correlating interventional radiology procedures to medical billing codes.
2. Description of Related Art
The Health Care Financing Administration (HCFA)--the government agency assigned the responsibility of overseeing the Medicare program--had adopted the Physician's Current Procedural Terminology (CPT) medical coding system of the American Medical Association (AMA) for reporting physicians' services to the Medicare program and to calculate the fees and costs associated with such services. The Medicare payment system, starting in 1992, is based upon a resource based relative value scale which assigns specific relative value units (RVU) to each specific procedure corresponding to a CPT code, The majority of private insurance companies have also started using the CPT coding system as a basis for their payment schedules. Accordingly, physicians must code their examination procedures according to the CPT coding system in order to be paid for their services from these organizations,
The AMA has structured the CPT coding system into five main procedure rubrics: Medicine; Anesthesia; Surgery; Radiology; and Pathology. The CPT coding system uses a five digit code to identify a particular type of procedure within each rubric, Each code typically covers a category of specific medical procedures. For example, a vascular injection into the right common carotid falls under the Surgery codes and, in particular under the procedural category of introducing a needle or intracatheter into an initial second order vessel within a vascular family of the thoracic or the bracheocephalic branches (specifically CPT code 36217).
Some medical specialists find the CPT coding system difficult to use because many modern medical specialties fall within several of the enumerated rubrics. For instance, Interventional Radiologists ("Interventionalists") especially view the new coding system as arduous because interventional radiology crosses many radiological and surgical sub-specialties, each of which falls under a specific CPT coding system rubric. For instance, if a radiologist examines a patient's left vertebral artery, the corresponding CPT codes for the examination would contain both Surgical codes and Radiology codes. Specifically, the CPT codes for this examination would be 36216 for the surgical component of the examination and 75685 for the radiological component of the examination.
Another complication of the CPT coding system specific to interventional radiologists is that the surgical codes for angiographic procedures require the interventionalist to identify the number of vascular families catheterized as well as the "order" of the vessel that was studied.
A vessel family is a group of vessels that share a common vessel or origin arising from either the aorta or one of the vena cavae. For example, the right renal artery and all of its branches represent one vascular family, the common origin of which is the main right renal artery. The order of a vessel is defined as follows: a first order vessel is the first branch or tributory of a family that arises from the aorta or one of the vena cavae; a second order vessel is simply the next branch or tributary of a first order vessel; and a third order vessel is the next branch or tributary of a second order vessel.
Within each vascular family, the properly assigned CPT code corresponds to the highest order of vessel catheterized. Additional third order and second order vessels studied within a vascular family also receive credit. The first order and higher order fees already include the fee for non-selective catheterization (i.e., catheterization of the aorta or one of the vena cavae), and, thus, the non-selective catheterization is not charged separately.
The CPT coding system requires a working knowledge of the medical procedures involved in order to receive proper compensation, and, thus, clerical personnel commonly improperly code examinations. Because an accountant or billing clerk typically does not understand the medical procedures involved, many performed procedures not identified by the physician in the CPT coding format go unbilled. Furthermore, even if the person coding the examinations understands the procedures involved, he or she is likely to overlook some intermediate procedures. Moreover, correlating the CPT codes with the procedure involved is virtually impossible without fully understanding the medical nomenclature used by the CPT coding system.
Additionally, physicians and clerical personnel often do not accurately translate the performed medical procedure into the CPT coding format because of the complexity of the CPT coding system. For example, if a radiologist examines a right vertebral artery by arteriography, including a vascular injection, one particular CPT code would correspond to the vascular injection. However, if the radiologist additionally examines a patient's right common carotid, a different CPT code would correspond to the vascular injection associated with the examination of the patient's right vertebral. In many situations, a straight reading of the CPT code will not provide the proper billing code and the physician or clerical personnel must review an entire CPT rubric to determine the proper billing code, or must memorize how certain procedural codes interact. Memorizing all of CPT codes applicable to the physicians' practice, however, would be impracticable (in the case of the interventionalist, it would be impossible), and using a truncated, but manageable list would be inaccurate. Thus the physician is forced to learn the workings of each applicable CPT rubric, a tedious and time consuming task, exacerbated by the fact that the CPT codes commonly change from year to year.
The CPT coding system is also imprecise in some areas and the physician and/or clerical personnel must learn to compensate for the inexactness of the CPT coding system. For instance, if a radiologist examines a patient's celiac and superior mesenteric arteries, the CPT coding system does not provide separate codes for these vascular families. Moreover, the CPT coding system does not provide separate codes for examination of particular vessels within these vascular families. The physician and/or clerical personnel must therefore realize that a duplicate CPT code for this procedure would be appropriate and code the examination accordingly.
Because of the complexity of the CPT coding system outlined above, payments from Medicare and private insurance companies commonly lack parity with the physician's services. Moreover, physicians are commonly required to code examinations themselves because the CPT coding system demands a thorough understanding of the medical nomenclature used by the CPT code. However, coding is a time consuming task for a busy physician.
Thus, a need exists for a method and a system for implementing the method for rapidly and simply correlating CPT codes with medical procedures performed during a patient examination which does not require a thorough understanding of the nomenclature used by the CPT coding system.